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Date 17/S/QG <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />Mailing <br />Describe Proposed Work <br />�� ���STING L�Z`,�`' <br />0 <br />P�RMIT <br />Q <br />O <br />� OOP Oc3 <br />� G OOO VJ C� V7 <br />� CJ MOG �O O� <br />� N �O � ,-i xV C..J t�� <br />f y� yt eT �p � <br />� � <br />\ <br />CiiC�i' 3 �. <br />r�c�xcv2�� <br />Q J W � � � x <br />m O_SfilNt7t� <br />City <br />Pu�lic Wo�ks Parmlt > �i�lY-- / <br />eiae.oeo��+ 46364 _ <br />Publ¢ Works Fee $ <br />total Feo <br />Less Ppo� Fee Paia 5— <br />Balanca Due 5 �21 <br />7�✓`1' iiro2 <br />i nat� <br />ZiP Phone <br />�;,, Phone <br />Proiect Address (if known) � �' " - � � � � - <br />Attach (our (4) copies ot plans tor proposed work - Drew to scale and rote � Ceo11eW�ne ot sheet able: <br />• Property Lines � Indicale North <br />• OuUine and dimensions of all existing and � Show any proposed grading changes <br />proposed structures on the lot � ghow measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall he performed in accordance with this permit and current Cily of Everett Desi9n and Conslruclion <br />Standards and Specifications. <br />3. Call Location Underground Service 4d hrs. before you dig. TOLL FREE NUMBER 1•800•424•555 . <br />q, gr,r.p crty stre�t� clemi at all timcs. <br />�, Curb ,e,utter and sidcwalk in ihe plai ve new a�id unJama�rd, ,ury da�nage tLereto sh�ill Ue repiaced at thc: <br />discrction of Ihc Public ��'orks Lispcetor. <br />(,. Arrv chanve in the drivew�+y cnt nmst be ,�pproved hy the Fublic Works Inapector. width at prop Gne <br />IIIWICII (V GXI5IIIIF� 8�11011 WIII(II. DIIYCIVB)' III;I}' IBNCf f,',�:III!I:IIIV 10 IIICCI Ki118�'C (IOUI� Ct1I1FIlICC (�Of :111 <br />spproeed 3 c;� gar;igel. <br />;. Adjust w;iter boxes to Macte at end of consmretiou. <br />3. LUts 5 lluu l? ,Lall dischugc: roollop dr�miagc to tlic storm drain stuU providcJ to thc lot. <br />9. Lols 1 tl�ni � slrall discharge rooltop draina�e to the lnt� inhltrarion treuch as per Ihe "Pispersion Tre.nch <br />De�a�l" on sLeei > �f Qie p�ais consinic�ions plans. A preconsuucrion meeting must be scheduled with �U <br />L,,��;e (lgg.9(>55 mob, or'_59.SS10 ol�ice) ptior to iuslallation of Ilre inliltrafion •�y'stem. Any change in <br />tli; inlilhatinn trcnch nmst he �pprnved by �he Fnblic �'nrks Tnspector. <br />�,�.P�'I�,�-�� z/�/9s <br />qppr vo ed lo �onstruction <br />i / Date <br />l/ f ��� 9 <br />FI L INSPECTION � � Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />V � <br />� <br />a <br />The undersigned owner/app�icant hereUy agrees to hold and save harm- <br />less the City of Everett irom any and all claims for damages. costs, <br />expenses, or causes ot adion that may arise because ol installation <br />and maintenance of ihe improvemenl or other right-ohway use hereto <br />applied for and further agre�esefo �a �°aeed hereby.n notice from Ihe <br />City and to replace pu � P P Y 9 <br />� � _ �—/rs � <br />u �� <br />Date <br />S nature of Applicant <br />WORK UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />